{"id":493,"date":"2020-06-19T13:38:15","date_gmt":"2020-06-19T13:38:15","guid":{"rendered":"https:\/\/maq.dreamhosters.com\/rapid-response\/?p=493"},"modified":"2020-11-04T00:29:21","modified_gmt":"2020-11-04T00:29:21","slug":"covid-19-and-the-birth-of-the-virtual-doula","status":"publish","type":"post","link":"https:\/\/modil.io\/rapid-response\/2020\/06\/covid-19-and-the-birth-of-the-virtual-doula\/","title":{"rendered":"COVID-19 and the Birth of the Virtual Doula"},"content":{"rendered":"\n

As doulas and anthropologists, we have anxiously followed North American hospital<\/a> policies<\/a> that limit the number of support people who may accompany a birthing person to the hospital. We\u2019ve wondered what these shifting policies mean for doulas<\/a> \u2013 birth<\/a> workers<\/a> who provide continuous<\/a> emotional, physical, and informational support <\/a>to pregnant and laboring people \u2013 and those they accompany during labor. The COVID-19 pandemic comes on the heels of increasing attention to a maternal health crisis <\/a>that disproportionately impacts people of color <\/a>and the poor.<\/a> Doulas, long seen as serving upper middle class white women, are increasingly becoming a valuable<\/a> source <\/a>of advocacy <\/a>in the face of birth disparities. In data collected from 450 qualitative surveys, we address how US and Canadian doulas adapted to the constraints posed by virtual support, how this then shifted their perceptions of care, and how virtual doula work exposes existing inequalities.<\/p>\n\n\n\n

Just as hospitals began experiencing a large influx of patients with COVID-19, they also announced new policies<\/a> impacting birth. These new guidelines spanned from allowing only certified<\/a> doulas, often with their own personal protective equipment (PPE) and on pre-approved hospital lists, to forcing pregnant people to choose only one support person, and in extreme cases, to banning<\/a> any labor support\u2013 whether partner or doula.<\/p>\n\n\n\n

I am now working with clients who are fearful rather than excited. All of them are afraid. I am spending a lot more time helping them process a rapidly changing birth landscape. (New York)<\/em><\/p>\n\n\n\n

Doulas detailed shifting hospital, local, state or provincial policies, and described how difficult these have made the provision of in-person support.<\/p>\n\n\n\n

My city now has mandatory shelter-in-place and it\u2019s questionable whether doula care is an exception. Penalties for being out include a $5000 fine and up to 90 days in jail. But my client is a lawyer, so she drafted a memo on her firm\u2019s letterhead with her interpretation of the law. I plan to carry a copy of that letter and the signed doula contract in case I get stopped by the police on my way over to her house when she goes into labor.<\/em> (Maryland)<\/em><\/p>\n\n\n\n

In all locations, doulas are working with uncertain hospital protocols. A doula in Ontario reported, \u201cCurrently, all hospitals have limited policies to one support for a laboring person (though that continues to feel precarious). There have been several changes \u2013 from originally no change [to doula support], to unclear change to significant changes.\u201d Doulas responded to these uncertainties with frustration. One doula in Alberta said, \u201cThere is a sense of powerlessness all around, since this policy<\/a> change came from \u2018on high\u2019 without consultation of clients or doulas or even looking at possible solutions that would allow for both safety of medical care providers and the support that clients need in birth and postpartum.\u201d <\/p>\n\n\n\n

An outcome of changing policies forces women to choose between a partner or a doula. For some birthing people, especially when attempting aVBAC <\/a>or birthing as a sexual assault survivor<\/a>, a doula can provide more experience with comfort techniques and is better skilled at navigating the hospital space and personnel than a novice partner. A doula from Utah wrote, \u201cOne hospital treats doulas as members of their staff so long as they pass a health test and can verify they are a professional<\/a> doulas, not just a family friend sneaking in. The other hospital will only allow a doula if the partner agrees to miss the birth of his child.\u201d Another doula in Alabama explained, \u201cI have one client (first baby) who wants me there instead of her husband because she wants an unmedicated birth. An unthinkable choice.\u201d Although we heard a few examples of successful changes to doula<\/a> hospital policies<\/a>, overall the resounding response to COVID-19 from doulas across the US and Canada has involved transforming the ordinarily intimate and hands-on forms of care they provide into virtual support services. Many felt online support restricted their ability to protect birthing families. Some doulas saw the impact of restrictive policies as trauma on vulnerable bodies, \u201cI\u2019m seeing responses to birth, in pregnant people, to these new policies that I usually only see in assault survivors who are giving birth. So, it has affected my work in every way\u201d (Texas). <\/p>\n\n\n\n

As doulas, we\u2019ve had to grieve the loss of support we know we can offer. In many ways, even though we are all long-time experienced doulas, we\u2019re back to the discomfort of being \u201cnew\u201d doulas as we learn a new way of doing this work. (Alberta)<\/em><\/p>\n\n\n\n

Doulas described investing in new microphones and lighting to use with such platforms as Zoom, Loom, Facetime, WhatsApp, Slack, Marco Polo, Skype, BlueJeans, GoToMeeting, and Hangouts. New services have included creating relaxation scripts, virtual meditations, comfort measure videos, online perinatal education, and facilitating chat groups for moms. <\/p>\n\n\n\n

Doulas also wrote about collaborative on-line efforts with other doulas, for example, launching \u201ca 24\/7 virtual hotline\u201d in New York City, a new Facebook group called \u201cCalm During COVID (CDC)\u201d in Houston, and online weekly \u2018new moms meet-ups\u2019 in Toronto. Houston-area doulas described their virtual efforts this way: \u201cWe keep it up to date with verified information about changing medical practices and visitor guidelines. We post educational articles. We do self-care posts. We create space for all of the feelings.\u201d Even while collaborating with other doulas, the majority focused their efforts on supporting partners. A doula from Ohio shared, \u201cMy focus has changed from affirming my continuous support role to empowering, even more than ever, the partner to be responsible for practicing coping tools and understanding how to navigate the hospital maternity care system on their own.\u201d Some doulas expressed their concerns that women\u2019s partners were \u201cvery unprepared for being the only support person\u201d (Missouri). In response, some worked to resolve this issue by creating new virtual options like \u201cdoula skills for dad\u2019s webinars\u201d (Yukon).<\/p>\n\n\n\n

There is a lack of personal contact I would normally be allowed to provide. Basic human rights are being taken away and women are afraid. I work with young moms who are being talked into procedures they previously did not want. (Washington)<\/em><\/p>\n\n\n\n

Just as there have been critiques of doula services catering to affluent<\/a> white<\/a> cisgender <\/a>populations<\/a>, the new reliance on virtual care further exacerbates structural vulnerability<\/a> and worsens existing inequities<\/a>. Who has access to virtual doulas, which hospitals have sufficient network bandwidth, and how do care providers determine who is worthy of virtual doula care?<\/p>\n\n\n\n

From rural to urban spaces, some doulas described a digital divide based on race and class inequalities. In Rhode Island, a doula wrote, \u201cI primarily serve in the Black community, so it\u2019s hard for me to hold<\/a> space when my clients don\u2019t have Internet and have a limited cell phone plan.\u201d To add, without access to high speed Internet, doulas were unable to offer women their \u201ccontinuous<\/a> presence,\u201d which is the hallmark characteristic of doula care.<\/p>\n\n\n\n

Doula virtual support foregrounds ongoing hospital anxieties about privacy in recording<\/a> births. From Ontario we heard, \u201cVirtual support [is] not accepted, as local doctors think this will just \u2018stress\u2019 the birthing person.\u201d Limiting access to labor support exacerbates inequitable<\/a> maternal<\/a> healthcare. A California doula described, \u201cWhen my first client began pushing, her provider demanded they close the laptop. I soon received frantic text messages from the father saying they were alone and scared and didn\u2019t know what to do. But we were told my virtual presence wasn\u2019t allowed.\u201d Another Ontario doula described the impact of these restrictions, \u201cMy clients are living in a level of fear and uncertainty that no practitioner can undo \u2013 and while I try to soften the edges, I\u2019m aware that they are not receiving the full breadth of care they deserve.\u201d In these instances, how are laboring bodies read for worthiness by care providers and what can doulas do when their virtual window closes? <\/p>\n\n\n\n

Pandemics are useful mirrors<\/a> revealing both societies\u2019 \u201cflaws and their commitments.\u201d Attention to what happens to birth during a pandemic offers opportunities to better understand the problems and potentialities of reproduction. Doulas are a resource for families and communities, and they provide better<\/a> patient <\/a>outcomes<\/a> as well as personalized care. Critical analysis of doulas as they both encounter and redefine boundaries of care entails a corresponding focus on shifting hospital policies and their impact on birthing families. Will we see an increase in home births, self-directed births, midwives and doulas? Will we see a rise in obstetric violence, postpartum post-traumatic stress disorder or postpartum depression? Doulas offer us a window onto the shifting landscapes of care impacting our maternal health system during COVID-19. <\/p>\n\n\n\n

Julie Johnson Searcy <\/strong>is an Instructor at Butler University in the History and Anthropology Department. Her research in South Africa compares experiences of birthing women across clinical settings, and her research in the U.S. focuses on doulas, the politics of reproduction and birth culture. <\/p>\n\n\n\n

Angela N. Casta\u00f1eda <\/strong>is Professor of Anthropology at DePauw University. Her research explores the intimate labor of doulas; unpacking the social and cultural meanings of attending to women during the transition to motherhood.<\/p>\n","protected":false},"excerpt":{"rendered":"

As doulas and anthropologists, we have anxiously followed North American hospital policies that limit the number of support people who may accompany a birthing person to the hospital. We\u2019ve wondered what these shifting policies mean for doulas \u2013 birth workers who provide continuous emotional, physical, and informational support to pregnant and laboring people \u2013 and those they accompany during labor. The COVID-19 pandemic comes on the heels of […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"citeas":"Casta\u00f1eda, Angela N. and Julie Johnson Searcy. (2020) \"COVID-19 and the Birth of the Virtual Doula.\" Medical Anthropology Quarterly Rapid Response Blog Series, Accessed <>. https:\/\/modil.io\/?p=493.","footnotes":""},"area":[],"topic":[],"rr_category":[658,635],"rr_tag":[],"creator":[662,661],"class_list":["post-493","post","type-post","status-publish","format-standard","hentry","rr_category-covid-19-and-srh-mnh","rr_category-covid-19-responses","creator-angela-n-castaneda","creator-julie-johnson-searcy"],"_links":{"self":[{"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/posts\/493","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/comments?post=493"}],"version-history":[{"count":1,"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/posts\/493\/revisions"}],"predecessor-version":[{"id":494,"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/posts\/493\/revisions\/494"}],"wp:attachment":[{"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/media?parent=493"}],"wp:term":[{"taxonomy":"area","embeddable":true,"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/area?post=493"},{"taxonomy":"topic","embeddable":true,"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/topic?post=493"},{"taxonomy":"rr_category","embeddable":true,"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/rr_category?post=493"},{"taxonomy":"rr_tag","embeddable":true,"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/rr_tag?post=493"},{"taxonomy":"creator","embeddable":true,"href":"https:\/\/modil.io\/rapid-response\/wp-json\/wp\/v2\/creator?post=493"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}